During the past decade, cancer care in Ireland has been transformed…. Northern Ireland now has the best cancer outcomes in the United Kingdom, and among the best in all of Europe.
—Patrick G. Johnston, MD, PhD, FRCP, FRCPI
Patrick G. Johnston, MD, PhD, FMedSci, Professor of Oncology and President and Vice-Chancellor of Queen’s University Belfast, grew up in Derry, a city in Northern Ireland. Derry is distinct in being Ireland’s only remaining fully intact walled city, considered one of the finest examples of a walled city in all of Europe.
“My father was a teacher, as were a number of my aunts and uncles. I also had very good teachers in grade school and high school, so I was fortunate to have grown up in an atmosphere of education,” said Dr. Johnston. It was during his high school days at St. Columb’s College when Dr. Johnston’s future career path began to take shape.
“I was about 14 years old when I first thought about becoming a doctor. My decision was probably influenced by a mixture of things—an early interest in chemistry and biology, seeing people suffering and dying of diseases such as cancer, wanting to make a difference, and having relatives who were in the nursing profession,” said Dr. Johnston. He added, “At a young age, I also saw the positive effect a family doctor had on a sick person’s life.”
In 1976, at age 18, Dr. Johnston entered the University College Dublin, receiving his undergraduate degree with distinction in 1982. He stayed on at the Dublin University Hospitals to pursue further medical studies, and it was during that intense academic period that he said his critical thinking and clinical skills were honed. Dr. Johnston’s interest in pursuing a career in cancer care arose during his residency working with oncologists (Dr. Desmond Carney [Desmond N. Carney, MD, now at Mater Misericordiae University Hospital, Dublin] and Dr. Peter Daly [Peter A. Daly, MB, FRCPI, now at St. James’s Hospital, Dublin]) and cancer patients in the mid-1980s.
“In Ireland, cancer care was still quite underdeveloped. Seeing the challenges and suffering that cancer patients had to undergo motivated me to enter the field. But also, as I began to read the medical and scientific literature, I realized that the cancer field was rapidly evolving in other places, like the United States,” said Dr. Johnston.
“It was a time of high-dose chemotherapies for leukemia and lymphoma, and the first cures in testicular cancer, leukemias, and lymphomas were being recorded. It was a very different era from the one we inhabit now, but it was nonetheless exciting because, for the first time, patients were surviving cancers that had once been a death sentence,” he commented.
Yearning to participate in the new bench-to-bedside era of oncology, Dr. Johnston applied for a fellowship at the epicenter of cancer research and clinical trials, the National Cancer Institute (NCI). He was accepted and joined the Institute in 1987.
“The most important part of my fellowship at the NCI was the exposure to basic science and research and further clinical training in integrated cancer care. My fellowship at the NCI was where large elements of my later career were defined,” said Dr. Johnston.
Dr. Johnston was at the NCI for almost 10 years, and during that period, he developed as a clinician-scientist. “The approach of bringing knowledge obtained in research to clinical practice has been the foundation of my career. While at the NCI, I was fortunate to have had Dr. Bruce Chabner [Bruce A. Chabner, MD, now Professor of Medicine at Harvard Medical School and Director of Clinical Research at Massachusetts General Hospital Cancer Center, Boston] and Dr. Carmen Allegra [Carmen J. Allegra, MD, now Professor of Medicine and Chief of Hematology/Oncology at the University of Florida, Gainesville] as mentors. They remain close friends to this day,” said Dr. Johnston.
His early scientific work at NCI primarily involved understanding drug resistance and developing biomarkers to identify patients who wouldn’t benefit from chemotherapy, which at that time was quite revolutionary.
“I worked on the enzyme thymidylate synthase, which is the target enzyme for fluoropyrimidines. I also developed a number of bioassays to measure target enzymes and began working with the clinical trial cooperative groups, mainly the National Surgical Adjuvant Breast and Bowel Project (NSABP). We quantified the enzymes in tissues, actually showing how we could detect certain groups of patients who would never benefit from fluorouracil. At that time this work was considered cutting-edge science and got quite a bit of recognition in the United States,” said Dr. Johnston.
A Call From Ireland
In 1996, Dr. Johnston received a telephone call from Ireland, prompting a career-changing decision. “I was asked if I would consider a position a Queen’s University Belfast, which essentially would be charged with redeveloping cancer services in Northern Ireland. I was reluctant at first because my research at the NCI was going very well. But when I flew back to Ireland for a visit, I saw the opportunity to build a comprehensive cancer program in Northern Ireland and truly make an impact on cancer care throughout the country. After some reflection, I accepted the position,” noted Dr. Johnston. In 1996, Dr. Johnston became Chair of the Department of Oncology at Queen’s University Belfast.
“I started the development of a cancer program that would reach throughout all Northern Ireland, and part of the project included building a new cancer center. With the help of Dr. Richard Klausner [Richard D. Klausner, MD, now Senior Vice President and Chief Medical Officer at Illumina], who was Director of the NCI at the time, and Dr. Edison Liu [Edison T. Liu, MD, now Chief Executive Officer of The Jackson Laboratory], we set up a unique cancer consortium agreement between Northern and Southern Ireland and the U.S. Department of Health and Human Services to work together in creating cancer programs across all of the island of Ireland,” explained Dr. Johnston.
Launched in 1999, The Ireland–Northern Ireland–NCI Cancer Consortium set a number of goals, such as strengthening the capacity of cancer centers in Ireland, conducting cancer clinical trials, and enhancing opportunities for patients to participate in trials, as a way of improving care and reducing cancer mortality.
“The program brought about training opportunities and new linkages for nurses, psychologists, social workers, and physicians, and became a huge catalyst for the development of local cancer programs and registries. It is still flourishing; in fact, plans are underway for the fourth Ireland–Northern Ireland–NCI Cancer Consortium to be held next year,” said Dr. Johnston.
Dramatically Improved Outcomes
Reflecting on the progress in cancer care in Ireland, Dr. Johnston said, “During the past decade, cancer care in Ireland has been transformed. The number of oncologists has increased six- to eightfold. Moreover, cancer surgery is now being performed by specialists in surgical oncology—a drastic shift from a decade ago, when this very difficult surgery was performed by general surgeons. We now have a mature and well-developed referral pathways system with registry data that are linked to hospital records measuring population outcomes and a well-run clinical trial network with 15% of patients on clinical trials. And because of these innovative programs that monitor population outcomes, Northern Ireland now has the best cancer outcomes in the United Kingdom, and among the best in all of Europe.”
Asked why the NCI would take interest in such a large undertaking in a small European country, Dr. Johnston replied, “The NCI leadership recognized the importance of what we were doing, the enormous clinical impact, and our ability to measure patient outcomes in a population-based system in a relatively short time frame. Having NCI leaders such as Drs. Chabner, Klausner, Liu, and Allegra as such strong advocates who helped us from a distance also gave those in Ireland the needed conviction to tackle such a large and complex undertaking. It changed the culture here. You no longer have to convince people; they’re championing these innovative programs themselves.”
More recently, Dr. Johnston has built on the lessons learned from developing the cancer programs in Northern Ireland. Along with his colleagues and friends, Dr. Martin Murphy [Martin J. Murphy, DMedSc, PhD, FASCO, Executive Director of The Oncologist and previous Chairman of Conquer Cancer Foundation ASCO], Dr. Thierry le Chevalier [Thierry le Chevalier, MD, Director of the Institute of Thoracic Oncology, Gustave-Roussy, Paris], and many oncology colleagues and patient groups from across Europe, he has led the European Cancer Coalition and developed a “Patient’s Bill of Rights” as a charter and catalyst for cancer care across Europe.1,2
Recognition for Leadership
In 2013, Dr. Johnston was awarded the Bob Pinedo Cancer Care Prize [named for H.M. (Bob) Pinedo, MD, PhD, Professor Emeritus of the VU University Medical Center (VUmc), Amsterdam] in recognition of his pioneering work in cancer research and for his leadership in establishing a comprehensive cancer care and research program in Northern Ireland. Dr. Johnston remarked that the Pinedo Prize was doubly gratifying, as Dr. Pinedo was one of his close colleagues and mentors in Europe.
“When I returned to Europe from the NCI, one of the first things I did was sit down with Bob. I’d known him through the NCI EORTC [European Organisation for Research and Treatment of Cancer] program,” he recounted. “Bob was very helpful when I first began the comprehensive overhaul of the Northern Irish cancer system. His success in the Netherlands was well known, so when people saw him as my advocate and collaborator, it gave the whole project a can-do feel of optimism. Another thing that was important to me about Bob was his drive to make sure that his scientific work in the lab would ultimately benefit his patients. That ultimately became my overriding philosophy.”
Balancing the Lab and the Desk
Along with his hefty administrative work as President and Vice-Chancellor of Queen’s University Belfast, Dr. Johnston’s current research work is focused on understanding signaling pathways that are key determinants in drug resistance and trying to identify novel therapeutic targets.
“In my lab, we’re working on a protein called the FLICE-inhibitory protein, which regulates cell death,” he said. “We’re in the process of developing some possibly important therapeutic molecules related to that protein. I’ve also been active in developing new platforms using a disease-specific genomic approach to develop molecular stratifiers for prognosis in certain tumors, such as colorectal cancer.”
Dr. Johnston commented that due to the multiple hats he now wears, he doesn’t put his lab coat on as often these days, leaving the bulk of the day-to-day work to his well-trained staff. What does the super-busy Vice-Chancellor-scientist do to wind down? “I cycle in the hills of Donegal,” said Dr. Johnston. ■
Disclosure: Dr. Johnston reported no potential conflicts of interest.
1. Lawler M, Le Chevalier T, Banks I, et al: A Bill of Rights for patients with cancer in Europe. Lancet Oncol 15:258-260, 2014.
2. Lawler M, Le Chevalier T, Murphy MJ Jr, et al: A catalyst for change: The European Cancer Patient’s Bill of Rights. Oncologist 19:217-224, 2014.